10D1089079 CLIA NUMBER - ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE AT PALM COAST MEDICAL PLAZA

Laboratory Demographics

CLIA Number: 10D1089079

Facility Name: ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE AT PALM COAST MEDICAL PLAZA

Facility Address:
120 CYPRESS EDGE DR STE 210
PALM COAST, FL
ZIP 32137
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Facility Phone Number: 386 445-4750

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1841662871

Taxonomy: 261QU0200X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1089079
LAB Type	Physician Office
Facility Name	ADVENTHEALTH MEDICAL GROUP FAMILY MEDICINE AT PALM COAST MEDICAL PLAZA
Street	120 CYPRESS EDGE DR STE 210
City	PALM COAST
State	FL
ZIP	32137
Phone	386 445-4750
CertificateType	4
CertificateEffectiveDate	5/22/2023
CertificateExpirationDate	5/21/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024